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General NPI Number Information
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NPI Number | 1083317366
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Entity Type | Organization
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Legal Business Name | CHANGE AND EVOLVE
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Dates
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Enumeration Date | 03/24/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 14634 DIANE MANOR LN
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City | HUMBLE
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State | TX
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Zip | 77396-4560
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Country | US
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Telephone | 702-466-4841
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 273
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City | HUMBLE
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State | TX
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Zip | 77347-0273
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Country | US
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Telephone | 702-466-4841
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CASSANDRA BLACK
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Credential |
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Telephone | 702-466-4841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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